Botta, Dominique M

Botta, Dominique M is an individual health care provider with primary practice located at 1370 13Th Ave S Ste 115 , Jacksonville FL 32250-3206. She recently has only one registered license in Speech, Language and Hearing Service Providers / Audiologist, which is considered as her primary health care specialty. Botta, Dominique M can be contacted via phone (904) 202-6390.

Contact Information

Primary practice address
1370 13Th Ave S Ste 115 Jacksonville FL 32250-3206
Phone: (904) 202-6390
Fax: (904) 390-7388
Website:
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Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Audiologist 231H00000X AY2238 Florida

Profile Details

NPI number 1518434547
LBN Legal business name Botta, Dominique M
Credentials AU.D
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 29th, 2018
Last updated May 18th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518434547 NPPES
Florida Other AY2238 STATE LICENSE

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